Breast Cancer Screening Guidelines - dummies

By Marshalee George, Kimlin Tam Ashing

The purpose of breast cancer screening is, of course, early detection of breast cancer so you can get timely treatment if needed. The earlier anything is caught, the better. That’s a no-brainer, right?

Unfortunately, some people run into psychological barriers. Some refuse to have a screening mammogram, for example, out of fear of the unknown, or they just don’t want to know if they have cancer. Believe us when we say that, when it comes to cancer, ignorance is definitely not bliss.

Often individuals who avoid screening mammograms have already been through some earlier traumatic event. Some have had a close relative or friend who was diagnosed with breast cancer, and the progress of their disease has left a traumatized memory.

Screening is one thing you can do to be proactive about maintaining good health. We all may be diagnosed with a disease at least once in our lifetime but the disease does not have to be the cause of our death. Many who find out they have advanced breast cancer say in hindsight, “I wish I had gotten my mammogram every year,” or, “I wish I’d had my doctor check this lump on my breast two years ago,” or even, “I wish I hadn’t ignored the rash on my breast for nine months thinking it was eczema or dermatitis.”

Don’t let such regret happen to you. Make someone’s I wish be your I will.

Traditionally, screening mammogram starts at age 40. In recent years there have been controversial changes with the screening guidelines across many organizations. Some recommend beginning screening at a later age (between 45–50 years of age), and some recommend screening every two years (instead of annually) or only when you have a life expectancy of ten years or more.

The table shows some recent screening recommendations among some major medical organizations.

Breast Cancer Screening Guidelines

ACR 2010 ACBG 2011 ACS 2015 USPSTF 2016 AAFP 2016
Women 40–49 years w/avg risk Screening with mammogram annually. Screening with mammogram and complete a clinical breast exam with your doctor annually. Women 40–44 can choose to start annual screening with mammograms. The risk of screening and potential benefits should be considered. Women 45–49 should get mammograms annually. The decision to start having screening mammogram before age 50 is an individual one. If you have a higher value on the potential benefit than the potential harms, then you may begin screening every two years from ages 40–49. The decision to start having screening mammogram is an individual one. If you have a higher value on the potential benefit than the potential harms, then you may begin screening.
Women 50–74 years w/avg risk Screening with mammogram annually. Screening with mammogram and complete a clinical breast exam with your doctor annually. Women 50–54 should get mammograms every year. 55+ should switch to having mammograms every two years, or have the choice to screen annually. Screening mammogram every two years. Screening mammogram every two years.
Women 75+ w/avg risk Screening mammogram should stop when life expectancy is less than five to seven years on the basis of age and chronic medical conditions. Women should talk with their doctor to decide whether or not to continue to have screening mammogram. Screening should continue as long as the woman is in good health and is expected to live 10 or more years longer. Current research is insufficient to assess the balance of benefits and harms of screening mammogram in women 75 years or older. Current research is insufficient to assess the balance of benefits and harms of screening with mammography.
Women with dense breasts In addition to screening mammogram, an ultrasound can be considered. Insufficient evidence to recommend for or against breast MRI screening. Insufficient evidence to recommend for or against breast MRI screening. Current research is insufficient to assess the balance of benefits and harms of screening for breast cancer using ultrasound, breast MRI, or digital breast tomosynthesis (DBT) or other methods in women identified to have dense breasts on an otherwise negative screening mammogram. Current evidence is insufficient to assess the balance of benefits and harms of screening for breast cancer using ultrasound, breast MRI, DBT, or other methods.

Breast specialists and clinicians feel strongly about their patients doing breast self-exams, getting clinical breast exams, and completing screening mammograms. The USPSTF recommendations in the table do not come from a breast specialist who takes care of newly diagnosed breast cancer patients on a daily basis. Countless times we (your authors, who are breast cancer specialists) have had patients who come to see us with a complaint of a breast mass that they or their spouse has felt.

The organizations listed could not agree on the breast cancer screening guidelines. What is agreed upon is that you should start screening between 40–50 years of age. Talk with your doctor or healthcare provider to determine your risk for breast cancer and discuss whether you should have a mammogram. Therefore, you have to make an informed decision about your mammogram screening that is best for you, taking into consideration your family history, environmental exposures, health behaviors, and age.